Chen Lung Tsai - 03 Jul 2025 Form 4 Insider Report for CapsoVision, Inc (CV)

Role: Director
Signature: /s/ Tai Vivatvaraphol, Attorney-in-Fact for Chen Lung Tsai
Issuer symbol: CV
Transactions as of: 03 Jul 2025
Net transactions value: $0
Form type: 4
Filing time: 07 Jul 2025, 17:27:36 UTC
Previous filing: 01 Jul 2025
Next filing: 17 Sep 2025
SEC: View on sec.gov

Reporting Owners (1)

Name	Relationship	Address	Signature	Signature date	CIK
Tsai Chen Lung	Director	C/O CAPSOVISION, INC., 18805 COX AVENUE, SUITE 250, SARATOGA	/s/ Tai Vivatvaraphol, Attorney-in-Fact for Chen Lung Tsai	07 Jul 2025	0001307275

Transactions Table

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Ownership	Footnotes
transaction	CV	Common Stock	Conversion of derivative security		+91,432	+381%		115,456	03 Jul 2025	By trust.	F1, F2

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Date	Underlying Class	Amount	Ownership	Footnotes
transaction	CV	Series B Preferred Stock	Conversion of derivative security	$0	-71,429	-100%	$0.000000	03 Jul 2025	Common Stock	21,450	By trust.	F1, F2
transaction	CV	Series D-1 Preferred Stock	Conversion of derivative security	$0	-55,555	-100%	$0.000000	03 Jul 2025	Common Stock	16,683	By trust.	F1, F2
transaction	CV	Series E Preferred Stock	Conversion of derivative security	$0	-86,956	-100%	$0.000000	03 Jul 2025	Common Stock	26,112	By trust.	F1, F2
transaction	CV	Series H Preferred Stock	Conversion of derivative security	$0	-90,534	-100%	$0.000000	03 Jul 2025	Common Stock	27,187	By trust.	F1, F2

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	Each share of Series B preferred stock, Series D-1 preferred stock, Series E preferred stock and Series H preferred stock automatically converted into approximately 0.3003 shares of the Issuer's common stock upon the closing of the Issuer's initial public offering. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split of the Issuer's common stock effected by the Issuer on July 2, 2025 in connection with its initial public offering.
F2	The securities are held by The Tsai Family Trust, for which the Reporting Person, together with his wife, are trustees.

Content

Each share of Series B preferred stock, Series D-1 preferred stock, Series E preferred stock and Series H preferred stock automatically converted into approximately 0.3003 shares of the Issuer's common stock upon the closing of the Issuer's initial public offering. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split of the Issuer's common stock effected by the Issuer on July 2, 2025 in connection with its initial public offering.

The securities are held by The Tsai Family Trust, for which the Reporting Person, together with his wife, are trustees.